Who is missing out on surgery? Government releases first figures of 'phantom waiting list'

Jonathan Coleman says Government critics will always complain, but the only way to meet demand is to carry out more ...
ROBYN EDIE/FAIRFAX NZ

Jonathan Coleman says Government critics will always complain, but the only way to meet demand is to carry out more surgeries.

More than 5300 people missed out on the surgery they needed, within a three month period last year, because there wasn't enough resources to do it.

It's the first release of Government figures measuring the surgical need that was going unmet, by hospitals stretched to capacity and struggling to keep up.

And while it was well down on estimates of about 170,000 annually by some Government critics, Health Ministry officials warn the figures could get worse before they get better. 

Dr Philip Bagshaw: "If [the ministry] had been genuine about wanting to know the numbers, they would have set up an ...
JOHN KIRK-ANDERSON/FAIRFAX NZ

Dr Philip Bagshaw: "If [the ministry] had been genuine about wanting to know the numbers, they would have set up an expert panel of independent people."

Between July 1 and September 30, last year, there were 145,922 referrals for a first specialist assessment - the first hurdle to pass for any one needing an elective surgery, such as a knee or hip replacement. 

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Of those referrals 130,902 patients (90 per cent) were accepted for a specialist consultation, while 9,685 (six per cent) had their requests delayed so doctors could obtain more information. 

But 5,335 - or four per cent of patients - were declined because they did not meet their particular District Health Board's (DHB) threshold.

Threshold's vary between regions; patients in need of surgery are ranked by their pain and mobility - they only make it on to the waiting list if their score is high enough to meet five different criteria thresholds.

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Health Minister Jonathan Coleman moved to install a nationalised recording system to account for all GP referrals, after growing public pressure over the "unmet need" of people who could not meet with a specialist - even if doctors conceded they needed surgery. 

Successive Governments have argued the extent of the problem was difficult to gauge, because DHBs recorded data in different ways and often it was not complete. 

The release of a national recording system was still "developmental", according to a Ministry of Health briefing document. 

"For example, in July 2015 the percentage of referrals [that were classed] "declined - below the threshold" nationally, is four per cent. As the data quality and completeness improves, the true number of referrals "declined - below the threshold" nationally, may well increase to 10-15 per cent," ministry officials said. 

Coleman said DHBs adjusted threshold levels for publicly-funded surgery "from year to year, and have always done so". It was to ensure access was "fair and equitable", but if people were missing out the Government had to account for them. 

"No one has previously counted the outcome of these GP referrals, so the data is still being built up but this is the first step in producing an accurate picture. 

"It means we can make progress in actually continuing to meet the demand for surgery." 

Coleman said Government critics would always complain, but the only way to meet demand was to carry out more surgeries. 

In the 2014-15 financial year, 542,645 surgical and medical first specialist assessments were carried out. That was a 26 per cent rise from the 432,048 that were carried out in the 2008-09 year. 

Professor, surgeon and founder of the Canterbury Charity Hospital Philip Bagshaw questioned the integrity of the data, saying it had to be collected independently. 

"If [the ministry] had been genuine about wanting to know the numbers, they would have set up an expert panel of independent people". 

Coleman said the statement was "ridiculous". 

"In the end, he's either accusing DHBs of lying about their figures, or the Ministry of making things up, and I can assure you they're not. 

"I don't want to over-promise, but I think our opponents would have wanted it to be much, much worse, the fact is it isn't." 

Bagshaw said it was "obvious from those of us who are working in this area, that the unmet need has been slowly buried by progressive Government's over a number of years".

Labour health spokeswoman Annette King said she welcomed the figures, but how they were next used was important. 

There was also a "huge difference" between access thresholds for each DHB. 

She fair and equitable access did not exist - "we have postcode access". 

"Having gathered the data, what we want to now see is that there is equitable access for the common threshold," she said. 

"But also what this data doesn't seem to tell us is much about what the referrals were and who got the operations. 

"If they've done more elective surgeries than ever before, some of the things that I'm told about is what counts as elective surgery is at the low end of surgery, rather than the complex end." 

King agreed with Bagshaw that there did need to be an independent review of "what is the level of existing unmet need in New Zealand, before we even go forward".

Bagshaw, and a panel of experts, were working on an independent survey to first ascertain the most effective way of collecting the data. 

This release was the first phase of Government data. By April, information would be able to be broken down by DHB and the second phase would also measure referrals for other procedures, such as colonoscopies. 

 - Stuff

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